Graft Compliance and Anastomotic Flow Patterns

Abstract

The oscillatory flow patterns at the venous anastomosis of a hemodialysis angioaccess loop graft system were studied using two new compliant vascular prostheses: a longitudinally compliant polytetrafluoroethylene-composite (Baxter UltraflexTM PTFE-Plus) graft (BA) and a radially compliant ultrafine polyester fiber (TORAY-UFPF) graft (TR). A non-compliant Gore-Tex polytetrafluoroethylene graft was used as the control. The experimental grafts were 8 mm inside diameter X 25 cm long. Flow experiments were done in a transparent, elastic bench-top flow model; fabrication was based on silicone rubber casts obtained from femoral-to-femoral arteriovenous loop grafts surgically implanted in dogs. The loop graft constructed in the dog model was made to mimic the branchial-to-cephalic angioaccess loop graft commonly used in hemodialysis patients. The flow model was connected to a pulse generator, an adjustable arterial afterload, and a venous afterload. Under identical input conditions, the pressure and flow waveforms were monitored simultaneously at the proximal and distal ends of both the arterial and venous anastomoses. For each graft studied, the anastomotic flow field was visualized using laser illuminated hydrogen bubbles as tracers. At pulse rates of 60 and 90 beats/min, graft flow rates were 2.2 and 2.5 L/min, respectively. Among the grafts studied, measurable differences in pressure and flow wave attenuation and their respective phase lags resulted in characteristically dissimilar flow patterns at the venous anastomosis. Growth of the separation zone at the toe of the anastomosis, and the pattern of retrograde flow in the distal vein are visibly different in all three grafts.